HomeMy WebLinkAboutX2020-1261 - Permitsw City of Newport Beach - Building Division I IIII�I�IIIIIIII�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII COMB Permit: X2020-1261
r 100 Civic Center Drive, Newport Beach, CA 92660 X 2 0 2 0 1 2 6 1 Project No : 2012-2019
`- rr Permit Counter Phone (949)644-3288
3 - a Inspection Requests Phone (949)644-3255
"�irenY�4�.: Combination Type - BLDG Issued Date : 06/02/2020
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Inspection Area : 3
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST BE COMPLETED BY 06/03/2023 OR PERMIT WILL BE INVALID '
Construction Hours:
Monday -Friday 7:00 a.m. to 6:30 p.m. and Saturday from 8:00 a.m. to 6:00 p.m. No work on Sundays or Holidays
Job Address: 2141 INDIAN SPRING LN NB
Description: SFR *ADDITIONAL SCOPE* RETAINING WALL 4' HIGH X 25 LF (REV20-0808)
Legal Desc.: NTR 6689 LOT
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Owner: CHASON CLIFTON
Contractor: SWAN POOLS OF SOUTHERN CA Architect:
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Address: 2141 INDIAN SPRING LN
Address: 24512 BRIDGER ROAD Address:
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NEWPORT BEACH, CA 92660
LAKE FOREST CA 92630
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Phone:
Phone: 949.859-8466
Phone: State Lic:
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Applicant: ELLISON PAUL
Con State Lie: 440333
Engineer: LACHER TODD
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Address: 24512 BRIDGER RD
Lie Expire: 03/31/2022
Address: 1201 N TUSTIN AVE
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LAKE FOREST CA 92630
Bus Lie: BT96008994
ANAHEIM CA 92807
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Phone: 949-859-8466
Lie Exp Date: 0713112020
Phone: 714-630-6100 State Lic:C-067656 • • .
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Code Edit, 2016
Worker's Compensation Insurance
Designer:
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Type of Construction:
Carrier: STATE FUND
Address:
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Occupancy Group: U
Policy No: 9228545
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Added/New sq.ft. Bldg: 0
Expire: 0410112021
Phone:
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Added/New sq. ft. Garage: 0°,°
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No of Stories: 0
Building Setbacks Rear: 6'
Special Conditions: SOME LANDSLIDE
No of Units: 0
Front: 20'
Bldg Height: 0
Left: 6'
Bldg Sprinklers:
Right: 6'
Flood Zone: X
Use Zone: Parkin S aces:
0 Fire Hazard Zone : N
Construction Valuation: $3.000.00
Building Permit Fee: $412.00
Excise Tax: $0.00
Planning Department - Fire Department
Plan Check Fee: $0.00
Additional Fee: $0.00
Plan check Fee : $0.00 Fire Inspection:
$0.00
Overtime Plan Ck: $0.00
Grading Bonds Fee: $0.00
Fair Share: $0.00 Fire Plan Rev
$0.00
Investigation Fee: $0.00
Grading PC Consultant: $0.00
SJH Trans : $0.00 Demolition Fee
Record Management: $4.00
Grading Permit Fee: $0.00
In -lieu Housing Fee : $0.00 Building Dept Adm
$0.00
Energy Compliance: $0.00
Grading PC Fee: $0.00
Public Works Department - General Service
$0.00
CA Seismic Safety: $0.00
WQ Insp. Fee: $0.00
Park Dedication : $0.00 Refund Deposit
$0.00
Disabled Access : $0.00
PAN Plan Check: $0.00 Grading Bond:
$0.00
Hazardous Mat $0.00
Electrical %: $0.00
San Dist: $0.00
Building Green Fee : $1.00
Mechanical %: $0.00
NMUSD Fee: $0.00
$0.00
Plumbing %: $0.00
$0.00
TOTAL FEE : $417.00
Plan Check Fee:
$0.00 Fee Due at Permit Issuance :
$417,00
PROCESSED BY:
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PUBLIC WORKS APPROVAL:
ZONING APPROVAL:
PLAN CHECK BY: 1�1�
GRADING APPROVAL:
APPROVAL TO ISSUE:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the reasons) indicated below by the checkmark(s) I have placed next to the applicable item(s)
lection 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for
is permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
'rofessions Code) or that he or she is exempt from licensure and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
of more than five hundred dollars ($500).
1 I, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or (_) portions of the work, and the structure is not intended or offered for sale (Section 7044,
lusiness and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds or improves the property, provided that the
nprovements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the Owner -Builder will have the burden of proving that it was not built or
nproved for the purpose of sale).
I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not
pply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law).
I I am exempt kgrii jicensure under the Contractors' State License Law for the following reason:
ly my signature�below 1, acknowledge that, except for my personal residence in which I must have resided for at least one year prior to completion of the improvements covered by this permit, I cannot legally
ell a strylcture thailVave built as an owner -builder if it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and
troiee'iens Coc1E, ra pilable upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html.
ignature of Property Owner or Authorized Agent D
JCEKSED CONTRACTOR'S DECLARATION
flerebq affirm undar"nalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 70 0) o iv' ion 3 of the Business and Pro as ns y license is in full force
Jd effect. License 6(,e'ss License No Date Z - Contractor Signatu L
.r
VOR?MRS' COMPENSATION DECLARATION
MIMII". FAILURE%6ECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINA PENALTIES AND CIVIL FINES UP TO ONE HUN ED THOUSAND DOLLARS ($700,0001, IN ADDITION TO THE
:QST"C.OMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
f ebly affirm under penalty of perjury one of the following declarations:
31 hav2 and w1l:QIsinitain a certificate of consent to self -insure for workers' compensation, issued by the Director of Industrial Relations as provided for by Section 3700 of the Labor Code, for th
�woiimarp of the vioill; for which this permit is issued. Policy No.
1 %0L1 and wilN,1 1 workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensatiol
isurance carrier and policy number are:
;arrier Policy Number Expiration Date
me of Agent I.'""`
I certify that, in the p=perjury
ork for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agre
I, if I should becomompensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
nature of Applicant Date 1> �Z j2y
CLARATION REGATION NDING AGENCY
=.reby affirm under pt there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code).
tder's Name Lender's Address
my signature below, I certify to each of the following:
I am the property owner or authorized to act on the property o n 's behalf.
I have read this application and the information I have provide is correct.
I agree to comply with all applicable city and count r finance d ate laws relating to building construction. tj
I authorize representatives of this city or county toe t ab is roperty for inspection purposes. / 1 �Ll= 2 v l j /
Print Property Owner's or Authorized Agent's Name Date/ / Z
Inature of Prooertv Owner or Authorized Agent P Y 9
ACTION DATE BY DECLARATION OF / I REGULATIONS PART61OFTIITLE 40AND AQMD RULE CE WITH CODE OF AL I FOR OFFICE USE ONLY
I SUBMITTED
PERMITCANCELLED
CERTIFICATE OF I I/C /� / I� PRITFINAL 1A
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